一种利用立体光刻三维打印空心血管模型进行脑动脉瘤栓塞微导管热成型的新方法。
A New Method of Microcatheter Heat-Forming for Cerebral Aneurysmal Coiling Using Stereolithography Three-Dimensional Printed Hollow Vessel Models.
作者信息
Nakajima Sadao, Sakamoto Makoto, Yoshioka Hiroki, Uno Tetsuji, Kurosaki Masamichi
机构信息
Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan and.
Department of Neurosurgery, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan.
出版信息
Yonago Acta Med. 2021 Feb 1;64(1):113-119. doi: 10.33160/yam.2021.02.001. eCollection 2021 Feb.
BACKGROUND
To perform successful coil embolization of cerebral aneurysms, it is crucial to make an appropriately shaped microcatheter tip for an aneurysm and its parent artery. So far, we manually shaped a mandrel by referencing two-dimensional (2D) images of a rotation digital subtraction angiography (DSA) on a computer screen. However, this technique requires a lot of experience, and often involves trial and error. Recently, there have been increasing reports of manual mandrel shaping using a full-scale three-dimensional (3D) model of an aneurysm and its parent artery output by various types of 3D printer. We have further developed this method by producing a hollow model of an aneurysm and its parent artery with a stereolithography 3D printer and inserting a mandrel inside the model to fit and stabilize a microcatheter tip.
METHODS
Based on digital imaging and communications in medicine (DICOM) data obtained by rotational DSA, 3D images of an aneurysm and its parent artery were created and converted into standard triangulated language (STL) data. A hollow model was produced by extruding the STL data outward in the normal direction, and then a hole was made at the tip of the aneurysm using these STL data. We output these STL data to a stereolithography 3D printer. After cleaning and sterilizing the model, the mandrel was inserted in the direction of the parent artery through the hole made in the tip of the aneurysm and pushed in, creating the ideal mandrel shape. Twelve cases (14 aneurysms) were included in this study. A microcatheter tip was shaped by this method for patients who were scheduled to undergo coil embolization for an unruptured aneurysm.
RESULTS
In 13 of the 14 aneurysms, the microcatheter was easily guided into the aneurysms in one or two trials, the position of the microcatheter tip in the aneurysm was appropriate, and the stability during coil embolization was high.
CONCLUSION
Our method differs from the conventional one in that a hollow model made of resin is produced with a stereolithography 3D printer and that the mandrel is shaped by inserting it retrogradely into the hollow model. Using our new method, it will be possible to shape the tip of a microcatheter suitable for safe and stable coil embolization without relying on an operator's experience.
背景
为成功实施脑动脉瘤的弹簧圈栓塞术，塑造适合动脉瘤及其载瘤动脉形状的微导管尖端至关重要。到目前为止，我们通过在计算机屏幕上参考旋转数字减影血管造影（DSA）的二维（2D）图像来手动塑造心轴。然而，这项技术需要大量经验，且常常涉及反复试验。最近，越来越多的报告称使用各种类型3D打印机输出的动脉瘤及其载瘤动脉的全尺寸三维（3D）模型进行手动心轴塑形。我们通过使用立体光刻3D打印机制作动脉瘤及其载瘤动脉的中空模型，并在心轴内插入模型以适配和稳定微导管尖端，进一步改进了该方法。
方法
基于旋转DSA获得的医学数字成像和通信（DICOM）数据，创建动脉瘤及其载瘤动脉的3D图像，并将其转换为标准三角语言（STL）数据。通过沿法线方向向外挤压STL数据制作中空模型，然后使用这些STL数据在动脉瘤尖端制作一个孔。我们将这些STL数据输出到立体光刻3D打印机。在对模型进行清洁和消毒后，将心轴通过在动脉瘤尖端制作的孔沿载瘤动脉方向插入并推进，从而塑造出理想的心轴形状。本研究纳入了12例（14个动脉瘤）。对于计划接受未破裂动脉瘤弹簧圈栓塞术的患者，采用该方法塑造微导管尖端。
结果
在14个动脉瘤中的13个中，微导管在一两次尝试中即可轻松导入动脉瘤，微导管尖端在动脉瘤内的位置合适，且在弹簧圈栓塞过程中的稳定性较高。
结论
我们的方法与传统方法的不同之处在于，使用立体光刻3D打印机制作树脂中空模型，并通过将心轴逆行插入中空模型来进行塑形。使用我们的新方法，无需依赖操作者的经验，就有可能塑造出适合安全、稳定弹簧圈栓塞的微导管尖端。
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